POS0565 WORSE OUTCOMES LINKED TO ETHNICITY FOR EARLY INFLAMMATORY ARTHRITIS IN ENGLAND AND WALES: A NATIONAL COHORT STUDY
Authors: M. Adas, S. Balachandran, S. Norton, E. Alveyn, M. Russell, T. Esterine, P. Amlani-Hatcher, S. Oyebanjo, H. Lempp, J. Ledingham, K. Kumar, J. Galloway, S. Dubey
Journal: Annals of the Rheumatic Diseases (2022)

Background Patients from ethnic minority backgrounds suffer considerable health inequality, with generally poorer health outcomes relative to the rest of the population. 1 Further exploration of these differences is essential if we are to deliver the best care for all, and close the health gap for our patients. Objectives We used the National Early Inflammatory Arthritis Audit (NEIAA) to assess variability in care quality and treatment outcomes across ethnicities for patients diagnosed with early inflammatory arthritis (EIA) in England and Wales. Methods NEIAA is an observational cohort design. Data were from adult patients newly diagnosed with EIA, and seen by rheumatology in England and Wales between May 2018 and March 2020. Quality of care outcomes were assessed against six metrics contained within the National Institute for Health and Clinical Excellence (NICE) Quality Standard for Rheumatoid Arthritis. 2 Clinical outcomes were measured using DAS28. Outcomes were compared between ethnic groups (White, Black, Asian, Mixed, Other), and adjusted for confounders (age, sex, smoking, comorbidity, seropositivity and disease severity at presentation) using Logistic regression models with multiple imputation for missing data. Results Data for 35,807 eligible patients were analysed, of whom 30,643 (85.6%) were White and 5,164 (14.6%) were from ethnic minority backgrounds: 1,035 (2.8%) Black; 2,617 (7.3%) Asian; 238 (0.6%) Mixed; 1,274 (3.5%) Other. A total of 12,955 patients had confirmed EIA. Of those, 11,315 were White and 1,640 were from ethnic minority backgrounds: 314 (2.4%) Black; 927 (7.1%) Asian; 70 (0.5%) Mixed; 329 (2.5%) Other. Of 35,160 eligible patients who had data available, 14,803 (42.1%) were assessed by rheumatology within three weeks of referral. Of 9,900 EIA-eligible patients with data available, 5,642 (57.0%) started treatment within six weeks of referral. There were no significant differences in these outcomes by ethnicity. Ethnic minority patients did, however, have lower odds of disease remission at three months, relative to patients of White ethnicity (adjusted odds ratio 0.79; 95% CI: 0.65-0.96; p=0.02). This difference was due to lower odds of disease remission in Black and Asian patients, relative to White patients (Table 1). Ethnic minority patients were significantly less likely to receive initial treatment with methotrexate (0.68; 95% CI: 0.52-0.90; p=0.008) or with glucocorticoids (0.63, 95% CI: 0.49-0.80; p&lt; 0.001). Table 1. Associations between ethnicity and disease remission at three months in EIA patients Model Odds ratio 95% CI P-value Unadjusted All ethnic minority 0.76 (0.62,0.93) 0.01 backgrounds Black 0.48 (0.34,0.67 ) &lt;0.001 Asian 0.74 (0.59,0.93 ) 0.01 Mixed 0.61 (0.28,1.35 ) 0.22 Other 1.09 (0.71,1.68 ) 0.67 Age and sex-adjusted All ethnic minority 0.78 (0.63,0.96) 0.01 backgrounds Black 0.49 (0.35,0.69 ) 0.00 Asian 0.75 (0.60,0.94 ) 0.01 Mixed 0.63 (0.28,1.39 ) 0.25 Other 1.11 (0.71,1.71 ) 0.63 Fully-adjusted All ethnic minority 0.79 (0.65,0.96) 0.02 backgrounds Black 0.57 (0.41,0.79 ) 0.001 Asian 0.76 (0.62,0.93 ) 0.009 Mixed 0.63 (0.27,1.46 ) 0.29 Other 1.04 (0.71,1.54 ) 0.80 Conclusion The results from this large cohort demonstrate that some minority ethnic groups are less likely to reach disease remission in the early months following an EIA diagnosis. Our results are not explained by delays in referral or treatment. Intitial treatment strategies varied across ethnic groups. These data highlight the need for investigation into the possible drivers of these inequitable outcomes and reappraisal of EIA management pathways. References [1]Greenberg JD, Spruill TM, Shan Y, Reed G, Kremer JM, Potter J, et al. Racial and ethnic disparities in disease activity in patients with rheumatoid arthritis. Am J Med. 2013;126(12):1089-98. [2]NICE quality standard for rheumatoid arthritis in over 16s. Nice.org.uk. 2013 [cited 25 January 2022]. Available from: https://www.nice.org.uk/guidance/qs33/documents/previous-version-of-quality-standard . Disclosure of Interests Maryam Adas: None declared, Sathiyaa Balachandran: None declared, Sam Norton: None declared, Edward Alveyn: None declared, Mark Russell Speakers bureau: Has received speaker fees and educational grants from Janssen, Lilly, Menarini, Pfizer and UCB, Tom Esterine Speakers bureau: Patient review of P.I.S and consent form into lay language for KCL that was linked to Pharma company., Paul Amlani-Hatcher: None declared, Sarah Oyebanjo: None declared, Heidi Lempp: None declared, Jo Ledingham: None declared, Kanta Kumar Speakers bureau: Has received training form Pfizer and speaker fees 2021 from Janssen., Paid instructor for: Has received training form Pfizer, James Galloway Speakers bureau: Has received honoraria from AbbVie, Celgene, Chugai, Gilead, Janssen, Eli Lilly, Pfizer, Roche and UCB., Shirish Dubey: None declared.